The Interview Issue

Bill Gates on His Foundation's Health and Education Campaigns

Photograph by Mark Peckmezian for Bloomberg BusinessweekGates outside his office at the Bill and Melinda Gates Foundation

You recently tweeted that very rare clip of FDR being pushed in his wheelchair in 1944. Why did you find that to be a powerful image?Polio eradication is this amazing effort. We’re raising the money to get it done by 2018. When these problems leave the rich world, they’re out of sight, out of mind. And reminding people of what a big problem it was and how amazingly others responded—which is why we have these tools at all—helps people, saying this can be the second disease to be eradicated.

What are the prospects for the eradication of polio and malaria?Polio is where we have a very concrete plan. It’s raising $5.5 billion—of which the [Bill & Melinda Gates] Foundation is going to give $1.8 billion. If we get credibility from the polio success, we can be more articulate about a malaria or measles elimination plan. The big one would be malaria, but that’s a long-term, in-my-lifetime-type thing, not imminent.

Can you share experiences in your travels that persuaded you to spend your time and money trying to improve global health?In the rich world, the death of a child is very rare. This idea that there are places in the world where a quarter of the kids die before the age of 5, that’s very foreign, and it’s very graphic when you go and see all these kids with malaria. You go out in the field, which I get to do two or three times a year, and talk to mothers who’ve had their children die. You’re always reminded that the world you live in is not the average place.

How do you stay an optimist?The percentage of kids who die, even during the time the foundation’s been involved in this, has gone from about 9 percent—this is the global average—to below 6 percent. So, by getting new vaccines out, we’ve had more progress in the last decade than ever before. The thing that’s so amazing is that in the 1960s, a third of the world was rich and two-thirds was very poor. Now the biggest block of the world’s population is middle-income: Brazil, Mexico, Thailand, China. The size of the very poor world is much smaller.

Are you seeing a direct connection between public health and political stability and economic growth?In every country that’s moved to middle-income status, they improved health dramatically, which both cut the death rate but also improved the human talent pool. The health and agriculture interventions were somewhere in the 10 to 20 years before they got out of the poverty trap.

One of Google’s (GOOG) convictions is that bringing Internet connectivity to less-developed countries can lead to all sorts of secondary benefits. It has a project to float broadband transmitters on balloons. Can bringing Internet access to parts of the world that don’t have it help solve problems?When you’re dying of malaria, I suppose you’ll look up and see that balloon, and I’m not sure how it’ll help you. When a kid gets diarrhea, no, there’s no website that relieves that. Certainly I’m a huge believer in the digital revolution. And connecting up primary-health-care centers, connecting up schools, those are good things. But no, those are not, for the really low-income countries, unless you directly say we’re going to do something about malaria.

Google started out saying they were going to do a broad set of things. They hired Larry Brilliant, and they got fantastic publicity. And then they shut it all down. Now they’re just doing their core thing. Fine. But the actors who just do their core thing are not going to uplift the poor.

The Gates Foundation has been criticized for being so big that it’s somehow distorting the agenda, particularly in higher education. What do you think of the argument that you and your allies aren’t being challenged because everyone is angling for your largesse?When we get into a field, we do take a point of view, and raising controversy is a symptom. Fortunately, there is what’s called the charter school format that lets you try new things. The system is good at shutting down the ones that don’t work and replicating the ones that do. The big actor is government. If somebody says somebody is too big, it would be strange to point to us.

What have you learned so far about MOOCs, or massive open online courses? Are they a superior alternative to traditional classrooms, or is this the best available solution for students who can’t attend a traditional university?If you look at who’s used MOOCs so far, it’s an elite phenomenon. The completion rates are very low, and the effect on employability is very low. Yes, it’s promising and exciting. But this notion that “just don’t go to school, just connect to a MOOC,” that’s like telling somebody to read the textbook. You’d have to couple that with student support, study groups, lab activity, and the credential. And until you complete that equation, MOOCs have not changed higher ed.

Are you optimistic that we can slow down climate change?Anybody who says we’re close to the solution isn’t looking at the whole systems requirement. There’s 20 companies that I have investments in—some batteries, some solar-thermal, one big nuclear thing. We need hundreds and hundreds of companies like that, so that in a 20-year time frame we really are starting to change the energy infrastructure.

And yet the prevailing sentiment in Silicon Valley seems to be negative because the first batch of companies failed.Some of those didn’t have contributions that would have made that much difference. We can’t depend on being faddish in Silicon Valley. The ease with which you get product adoption in the IT sector does make you naive when you move into non-IT sectors, including energy, about the life cycles, reliability, regulatory framework.

What does winning look like for the Gates Foundation?If the death rates of poor children come down to the amazingly low rate of rich children, that would be a signature accomplishment. In the U.S., if we have an education system where the inner-city kid and the suburban kid have equal opportunity, that would be a huge contribution.

How do you compare the challenges of the first part of your career—changing the way we work and live, putting a PC on every desk—with the challenges of the second part?I was very fulfilled in my 20s and 30s being a fanatic about the magic of software. What I’m doing now is more similar to that than you might think in terms of picking people to pursue a malaria vaccine or figure out how to get stuff delivered in the field. I don’t work day and night like I did in the early part of Microsoft (MSFT), because I’ve got a family. It’s a little less fanatical.

Do you miss having an operational role now, especially because in some markets Microsoft is an underdog again?No, the importance of software and digital approaches, the opportunities and the room for innovation is such that there’s a lot of people doing good work, including Microsoft. And I’m engaged a bit there part-time. I’m on the board. It is a trade-off. I’ve chosen to focus more time on the foundation, so I don’t get to do quite as many magic whiteboard meetings.

There are other successful businessmen who are orienting their extracurricular interests around space exploration. Is that interesting to you? Is that worthwhile for humanity?Everybody’s got their own priorities. In terms of improving the state of humanity, I don’t see the direct connection. I guess it’s fun, because you shoot rockets up in the air. But it’s not an area that I’ll be putting money into.

Stone is a senior writer for Bloomberg Businessweek in San Francisco. He is the author of The Everything Store: Jeff Bezos and the Age of Amazon (Little, Brown; October 2013). Follow him on Twitter @BradStone.